Provider Demographics
NPI:1346969474
Name:ARAUJO, EDELYN DENISSE
Entity Type:Individual
Prefix:
First Name:EDELYN
Middle Name:DENISSE
Last Name:ARAUJO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2095 COTTONWOOD CIR APT 209
Mailing Address - Street 2:
Mailing Address - City:EL CENTRO
Mailing Address - State:CA
Mailing Address - Zip Code:92243-4233
Mailing Address - Country:US
Mailing Address - Phone:760-455-5326
Mailing Address - Fax:
Practice Address - Street 1:768 GRANT ST
Practice Address - Street 2:
Practice Address - City:CALEXICO
Practice Address - State:CA
Practice Address - Zip Code:92231-3436
Practice Address - Country:US
Practice Address - Phone:760-693-0046
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-23
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAY3336030OtherDRIVER LICENSE